The Canada Health Act says all permanent residents of this country are entitled to “reasonable access to health services without financial or other barriers.” But for an increasing number of low-wage workers, seniors without personal savings and families with no health insurance, cost is a barrier — an unscalable one.

The extent of this inequity was underlined last week by a new report from Statistics Canada. It showed that out-of-pocket expenditures for health-care (primarily prescription drugs, dental services and private insurance premiums) shot up by 63 per cent for the poorest fifth of the population between 1997 and 2009. Those in the middle-and upper-income quintiles experienced increases ranging from 36 per cent to 48 per cent.

Even these stark figures are already out-of-date. Since Statistics Canada stopped counting, the average Canadian’s drug bill has risen from $735.66 to $826.80.

None of this is a surprise.

The National Forum on Health, created by former prime minister Jean Chrétien in 1994, foresaw it. It called for a universal pharmacare program in its 1997 report.

Roy Romanow foresaw it in his 2002 report on the future of health care in Canada. Conscious of past failures, he chose an incremental approach, urging Ottawa to cover half the cost of essential medications for those spending $1,500 a year immediately.

The C.D. Howe Institute, with its large corporate clientele, joined the chorus in 2013. “Integrating pharmaceuticals into the health-care system by covering medically necessary prescription drugs at little or no cost to patients would result in improved performance,” it concluded after an exhaustive analysis of existing provincial programs.

Groups such as the Canadian Health Coalition, Doctors for Medicare, with a ground-level view of health care, have been sounding the alarm for as long as they’ve existed. “Every doctor and almost every clinic you go to will have a story of a patient who they’ve prescribed medication for but because they don’t have coverage, they are not able to pay for it,” said Dr. Danyaal Raza, who works in a community clinic in a low-income Ottawa neighbourhood.

Ottawa did make one half-hearted attempt to launch a national pharmacare program. In 2004, then-prime minister Paul Martin transferred an unprecedented $41 billion to the provinces to “buy change.” The provinces, in turn, agreed to make five fundamental reforms over the next decade. One of them was a national drug strategy which would lay the groundwork for pharmacare.

The provinces acted on one of Ottawa’s priorities: cutting wait times for high-volume surgeries. But they used the rest of the federal money to do what they’d done always done — pour more money into acute care, pay off hospital deficits and plug holes. Pharmacare fell by the wayside.

Prime Minister Stephen Harper shrugged. Former Ontario premier Dalton McGuinty persuaded his provincial colleagues to participate in a bulk buying plan for generic drugs, but their commitment waned when he left politics.

The result is clear: Governments are pushing patients out of hospitals faster, saddling them (except those on social assistance and old age security) with the cost of their own prescriptions. What this means is that the core principle of medicare — that every Canadian should have equal access to health care regardless of wealth — is deteriorating.

As always, the poor are first and hardest hit. The majority of middle-income Canadians have private health insurance. The rich don’t need pharmacare; they can cover the cost of their own medications.

But what typically happens when a universal program erodes is that damage works its way up the income ladder. There are already isolated cases of patients whose insurers won’t pay for astronomically priced drugs. There are stories in the media about families of all socio-economic levels begging governments to help them pay for rare and costly medications.

There is still time to fix this problem. What is missing is the political will.

Carol Goar's column appears Monday, Wednesday and Friday.

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